The liver is the largest organ in the body and performs many vital functions. It synthesises albumin, bile and blood clotting factors. It also processes the nutrients we absorb and metabolises drugs and toxins in the blood.

Cirrhosis results from damage to liver cells by inflammation, toxins and metabolic derangement. These damaged cells are then replaced by new liver cells regenerated in an abnormal pattern forming nodules surrounded by fibrous or scar tissue. As more and more scar tissue is formed, diffuse changes to the liver architecture result in abnormal blood flow to the liver cells and reduced liver function.

Chronic Hepatitis B is the commonest cause of cirrhosis in Singapore affecting a fifth of patients with chronic hepatitis B virus infection. The process is gradual, over a few decades. In contrast, alcohol abuse and Hepatitis C are the 2 major culprits in the West. Other less common causes include autoimmune liver disease, where there's lack of self-recognition leading to destruction of the liver by our own body's defences, inherited diseases associated with problems of handling our body iron or copper, certain more severe form of fatty liver. Prolonged exposure to certain drugs and toxins are uncommon causes as well. Sometimes, by the time the patient presents with feature of cirrhosis, what is left is the evidence of the consequence of previous destruction, the cause of which may never be found.

Many have no symptoms in the early stages of disease. With time however, the following may occur: fatigue, loss of weight and appetite, nausea, jaundice, abdominal and lower limb swelling, itch, and confusion. Red blotches may appear on the chest, red palms may develop and men may develop breast tissue.

Some obvious physical features of cirrhosis may be found when a doctor examines you. He will usually need to do some blood tests, including liver function test, and will likely to send you for a scan of your liver. Some patients may require a liver biopsy for confirmation of the diagnosis, as well as to look for the underlying cause of the cirrhosis.

If you have not previously been screened or vaccinated against hepatitis B, you should have this done. Patients with chronic hepatitis B virus infection (or commonly called hepatitis B carriers) should be followed up by a regular doctor so that timely treatment can, hopefully, lower your risk of developing cirrhosis in the long run.

Consult a doctor early if you have any of the symptoms listed above or a family history of liver cirrhosis or liver cancer. Once diagnosed with liver cirrhosis, you should:

Your doctor may advise gastroscopy to look for varicose veins in the gullet. If these are present, you will require medication to reduce their likelihood of rupturing. If you have already bled from these, you will need a few gastroscopic sessions to tie up these veins completely. You may also require diuretics, which are pills to rid of the fluid collection in your legs or abdomen. You will benefit from laxatives to reduce build up of gut toxins, particularly if you have noticed problems of poor concentration, insomnia or confusion.

Cirrhosis per se is not reversible but medication is available to treat certain underlying causative diseases, thus slow the progression of the disease. Also, many patients who stop abusing alcohol find that their livers improve a great deal.

When more and more healthy liver cells are replaced by scar tissue, the liver becomes less able to perform its inherent functions, thus, the beginning of liver failure. You may experience tiredness, poor appetite, jaundice, itch, swelling, and poor concentration or confusion.

Liver failure can also be an acute or fulminant process. Here, a patient has no previous longstanding liver disease but has recent exposure to a severe insult to the liver in the form of a virus, e.g. acute hepatitis A or B, or drugs and toxins. Symptoms are non-specific initially, including nausea, loss of appetite and abdominal discomfort, progressing over a few days or weeks to confusion, jaundice and drowsiness.

Both categories of patients may benefit from liver transplantation; a decision to be made based on the patient's clinical condition and blood tests results. With improved surgical techniques and medical care, more than 70 to 80% of patients are now surviving longer than 5 years after a liver transplant.